Mental Health Access Improvement Act Re-Introduced In Congress
Posted by donna@healthlawcenterplc.com in Jun, 2019
The Mental Health Access Improvement Act (S. 286) was re-introduced by Senator Stabenow (D-MI) and Senator Barrasso (R-WY), which will allow mental health counselors to bill Medicare for treating older adults with mental health conditions. The American Mental Health Counselors Association was instrumental in the introduction of S. 286. In the House, Rep. Thompson (CA-05) […]
Category: Licensure, Medicare, Mental Health, Michigan Legal Updates, News & Updates, Reimbursement
Oops, They Did It Again: Will Your Medicare Part B Reimbursement Decrease?
Posted by donna@healthlawcenterplc.com in Sep, 2018
Every year the Centers for Medicare and Medicaid Services proposes Medicare Part B reimbursement rules for the upcoming year. The 2019 proposed rule changes could affect the amount of reimbursement physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists receive. If these proposed rules are finalized, clinicians could lose as much […]
Are You Defrauding Medicare By Either Upcoding Or Downcoding Submitted Claims?
Posted by donna@healthlawcenterplc.com in Aug, 2018
Both upcoding and downcoding are significant because these actions have been interpreted as a basis for abusing and defrauding the federal government and its programs. According to CMS, “abuse describes practices that, either directly or indirectly, result in unnecessary costs to the Medicare Program.” Abusive coding practices include: Upcoding – a code with a […]
Could A Sweetheart Contract Or Lease Turn Sour?
Posted by donna@healthlawcenterplc.com in Aug, 2018
Last week the United States Department of Justice announced a settlement agreement with William Beaumont Hospital, located in the Detroit area, based on allegations Beaumont made false claims to the Medicare, Medicaid, and TRICARE programs. The allegations are based on improper relationships with eight referring physicians. Under the settlement agreement, Beaumont is required to pay […]
Post Tagged with Donna Craig, False Claims Act, Fraud & Abuse, Medicare, Physician, Stark Law, The Health Law Center Now’s Your Chance To Tell CMS How You Feel About The Stark Law!
Posted by donna@healthlawcenterplc.com in Jul, 2018
The Centers for Medicare & Medicaid Services (“CMS”) is seeking public input on how the Stark Law may be impeding patient care coordination. CMS issued a “Request for Information” seeking comments from providers that participate in alternative payment models (value based programs vs. fee for service) that may require the need to revise or […]
Category: Medicaid, Medicare, News & Updates
Post Tagged with Centers for Medicare & Medicaid Services, Donna Craig, Medicare, Stark Law, The Health Law Center Physician And Two Nurses Found Guilty of $13 Million Home Care Fraud Scam
Posted by donna@healthlawcenterplc.com in Jun, 2018
Dr. Kelly Robinett a semi-retired emergency room doctor with more than 30 years of experience was convicted of fraud for his role in a $13 million home health care scam. After a weeklong trial before U.S. District Judge Reed O’Connor in Dallas, the jury issued its verdict after several hours of deliberations. Along with […]
Category: Anti-Kickback Statute, Medicare, News & Updates
Pfizer to Pay $23.85 Million for Alleged Violations of the Anti-Kickback Statute
Posted by donna@healthlawcenterplc.com in Jun, 2018
Pfizer was alleged to have used a tax exempt, non-profit foundation as a conduit to pay drug co-pays for Medicare patients who were either prescribed two Pfizer drugs for the treatment of renal cell cancer (Sutent and Inlyta) or another Pfizer drug for the treatment of atrial fibrillation or atrial flutter (Tikosyn). The Anti-Kickback […]
Category: Anti-Kickback Statute, Medicare, News & Updates
Post Tagged with Centers for Medicare & Medicaid Services, Fraud & Abuse, Medicare, Physician, The Health Law Center CMS Proposed Rule For Short-Term, Limited Health Insurance: Would You Get The Coverage You Expect?
Posted by donna@healthlawcenterplc.com in May, 2018
The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that seeks to expand the sale and use of short-term, limited duration health insurance plans (“skinny health plans”), by extending the maximum duration of such plans from three months to twelve months. These types of health insurance plans by definition are not required to […]
Category: Medicare
Post Tagged with Affordable Care Act, Centers for Medicare & Medicaid Services, Medicare, The Health Law Center Physicians to Pay $700,000 to Settle False Claims Action
Posted by donna@healthlawcenterplc.com in May, 2018
Three physicians located in Pennsylvania, Florida and Indiana agreed to settle allegations that they each received improper payments for referrals from Universal Oral Fluid Laboratories (UOFL), a Greensburg, Pennsylvania, drug testing lab. By accepting payments from UOFL, the three physicians caused false claims to be submitted to Medicare for drug testing services. According to […]
Category: Medicare
Post Tagged with Centers for Medicare & Medicaid Services, False Claims Act, Fraud & Abuse, Stark Law Medicare Improperly Paid for Telehealth Claims
Posted by donna@healthlawcenterplc.com in Apr, 2018
The Department of Health and Human Services Office of Inspector General (OIG) recently published Report A-05-16-00058 indicating that approximately one-third of Medicare telehealth claims in a recent audit did not meet reimbursement requirements. The audit was conducted on a sample of 100 telehealth claims from 2014 and 2015. Most of the rejected claims were associated […]
Category: Medicare, Telemedicine
